Abstract
Although Kenya nationally scaled up oral pre-exposure prophylaxis (PrEP) in May 2017, adolescent girls’ (AG, aged 15–19 years) and young women’s (YW, aged 20–24 years) PrEP use remains suboptimal. Thus, we analyzed PrEP consultations—interactions with a healthcare provider about PrEP—among Kenyan AGYW. In April-June 2018, AGYW enrolled in DREAMS in Kisumu County, Kenya self-reported their HIV-related knowledge, behaviors, and service use. Among HIV negative, sexually active AG (n = 154) and YW (n = 289), we examined associations between PrEP eligibility and PrEP consultations using prevalence ratios (PR, adjusted: aPR). Most AG (90.26%) and YW (94.12%) were PrEP-eligible due to inconsistent/no condom use, violence survivorship, or recent sexually transmitted infection symptoms. Between PrEP-eligible AG and YW, more YW were ever-orphaned (58.09%), ever-married (54.41%), ever-pregnant (80.88%), and out of school (78.31%); more PrEP-eligible YW reported PrEP consultations (41.18% vs. 24.46%, aPR = 1.51 [1.01–2.27]). AG who used PEP (post-exposure prophylaxis) reported more consultations (aPR = 5.63 [3.53–8.97]). Among YW, transactional sex engagers reported more consultations (58.62% vs. 39.09%, PR = 1.50 [1.06–2.12]), but only PEP use (aPR = 2.81 [2.30–3.43]) and multiple partnerships (aPR = 1.39 [1.06–1.82]) were independently associated with consultations. Consultations were lowest among those with 1 eligibility criterion (AG = 11.11%/YW = 27.18%). Comparatively, consultations were higher among AG and YW with 2 (aPR = 3.71 [1.64–8.39], PR = 1.60 [1.07–2.38], respectively) or ≥ 3 (aPR = 2.51 [1.09–5.78], PR = 2.05 [1.42–2.97], respectively) eligibility criteria. Though most AGYW were PrEP-eligible, PrEP consultations were rare and differed by age and vulnerability. In high-incidence settings, PrEP consultations should be conducted with all AGYW. PrEP provision guidelines must be re-assessed to accelerate AGYW’s PrEP access.
Highlights
Despite geopolitical commitments, increased donor investments, and novel program delivery, adolescent girls (AG, aged 15–19 years) and young women (YW, aged 20–24 years) remain at disproportionate risk of HIV acquisition [1]
Oral pre-exposure prophylaxis (PrEP)’s potential is wasted if it is inaccessible to individuals at substantial risk of HIV acquisition
To understand AGYW’s access to PrEP, we examined their PrEP eligibility and reports of PrEP consultations
Summary
Despite geopolitical commitments, increased donor investments, and novel program delivery, adolescent girls (AG, aged 15–19 years) and young women (YW, aged 20–24 years) remain at disproportionate risk of HIV acquisition [1]. Oral pre-exposure prophylaxis (PrEP) has become a primary focus of HIV prevention efforts because it is safe and highly efficacious [26]. Given their risk, AGYW are a priority population for PrEP, yet research suggests that PrEP access, uptake, adherence, and continuation is low among AGYW [15, 27,28,29,30]. Due to aggregated data sources, it is difficult to ascertain how many of these initiators are AGYW
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